Medicare Advantage Qualifier

Resume: Lois Lavon Shrader-Pressley

*************@*****.***

Education: Gaston College Associates Degree---Applied Science Medical Billing/Coding---Certificate

Life/Health/Accident---License (Compliant - 2026)

Medicare- AHIP Certification 2025

Employment History:

2023-2023 Tranzact Insurance (Remote)

Medicare Advantage Qualifier

Customer Service--Pre-Screened customers eligibility election status to optimize the maximum benefits in their area (Ex., IEP, OEP-1, SEP, AEP) Veriified customer data,SS#, DOB, name, demographic's, phone number. Assisted callers with inquiries pertaining to Medicare Advantage Plans, as-well-as assisted with Medicaid inquiries (Ex., phone numbers/addresses of their state/county agency). Document all conversations into the system. Provided unlimited assistance to the need of each customer. Built rapport with customers. Handled all policies and inquiries in accordance with HIPAA regulations.

2022-2022 Connexion Point (Remote)

Medicare Advantage Retention Agent (Inbound/Outbound)

Customer Service--Collected and verified data (Ex., SS#, DOB, phone#, demographic's and all other information necessary for transaction. Provided customer(s) detailed information regarding plan benefits relating to co-pays, coinsurance, deductibles, HMO/PPO providers for area. Also provided solid instructions how to qualify for extra benefits (Ex. QMB). Completed HRA's. Assisted callers with inquiries pertaining to Medicare Advantage Plans. Assisted with Medicaid inquiries (Ex., phone numbers/addresses of their state/county agency). Provided unlimited assistance to the need of customers. Built rapport with customers. Handled all policies and inquiries in accordance with HIPAA regulations.

2017-2018 GoHealth Insurance ACA

Healthplan Benefit Advisor Healthplan Benefit Advisor -- Affordable Care Act Program

Customer Service-- Provided initial support for customers with healthcare plans. Program plans were determine by using the needs analysis tool guide. Provided explanation of benefits which included copays, co-insurance, deductibles, Rx, provider lookup... Assisted with in-network vs. out-of-network coverage status. Collected medication information and discussed teir levels with customers. Collected and verified data which included SS#, DOB, phone#, demographic and all other PHI necessary for transaction, collected payment... Assisted customers with what their financial responsibilities would be if a claim had to be filed, which included co-payments, deductibles, and co- insurance. Provided unlimited assistance to the need of each customer. Followed/Safeguarded customer PI, followed protocol to HIPAA regulations. 2006-2009 Gaston Memorial Hospital

Prep/Scan Imaging Specialist (Medical Records)

Prepared medical charts for Document Management using methods of prepping, editing,indexing, scanning, and maintaining security/confidentiality of records and standards of ethics with all information. Handled all policies and inquiries in accordance with HIPAA regulations. 1

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